Rheumatic Heart Disease (RHD) is the most common and most serious complication of rheumatic fever. With chronic RHD, patients develop valve stenosis with varying degrees of regurgitation, atrial dilation, arrhythmia and with the development of heart failure,1 particularly when attributable to left ventricular systolic dysfunction, surgery has been inappropriately delayed. It is important to prevent irreversible damage to the left ventricle and irreversible pulmonary hypertension since both considerably increase the risk of surgical therapy and impair long termresult.

Surgery is performed with low mortality and most patients are expected to have an uncomplicated post-operative course.2 However, there remains a small subgroup of patients in whom the intensive care course before and after surgery is complicated and protracted. These "prolong stay" patients have a high mortality and morbidity rate. It is therefore the aim of this study to retrospectively review all children undergoing open heart surgery for rheumatic heart disease at our institution and attempt to identify specific pulmonary risk factors that may underlie increases in the duration of ICU stay in this patient population.